Casualty Claims Quality Assurance Consultant

At EMC, we’re all about working together to make an impact. As part of our team, you’ll have the opportunity to grow, contribute, and gain experience that matters. We strive to be caring leaders, close partners, and responsive experts—always supporting each other to do our best work. Join us, and let’s improve lives together.

**This position is eligible to work from home anywhere in the US**

In this role, you’ll play a key part in strengthening the quality and consistency of casualty claims handling across the organization. You’ll partner closely with Casualty, Complex, and Specialty teams to review claim files, evaluate performance against best practices and KPIs, and identify opportunities to improve outcomes. Through targeted audits and broader claims reviews, you’ll uncover trends, provide actionable insights, and help drive accountability and continuous improvement. You’ll also collaborate with leadership to shape audit standards, support training efforts, and implement process enhancements that elevate claims handling quality. Your work will directly impact how claims are managed by ensuring consistency, reducing risk, and improving overall results for both the business and its customers.

Essential Functions:

• Conducts casualty-focused file reviews across Regional, Complex & Specialty teams

• Measures handling quality against EMC Best Practices, Casualty KPIs, and state requirements

• Performs targeted audits on specific casualty focus areas with stakeholders

• Establishes audit standards and procedures with Claims/Casualty leadership

• Documents findings, analyzes trends, and identifies improvement opportunities

• Prepares and delivers audit reports, summaries, and presentations

• Recommends process improvements and future audit focus areas

• Communicates results and action plans to stakeholders

• Supports implementation of new audit processes and continuous improvement efforts

• Provides insights to drive consistency, accountability, and better claim outcomes

• Conducts claims-wide audits with leadership and QA partners as needed

• Adapts audit scope based on evolving business needs and priorities

• Participates in training sessions and shares audit insights with teams

• Assists with special projects, including guideline reviews and KPI-focused initiatives

• Collaborates cross-functionally to ensure audit and project goals are met

Education & Experience:

• Bachelor’s degree, preferably in insurance, finance, accounting, business administration or related field or equivalent relevant experience

• Eight years of commercial lines casualty claim handling experience, including experience with litigated claims or related experience

• Prior audit experience preferred

• Insurance industry designations (e.g. INS, AIC, CPCU) preferred

Knowledge, Skills & Abilities:

• Excellent understanding of the casualty claims function

• Strong understanding of casualty claims handling procedures, principles, standards and best practices

• Strong knowledge of medical and legal terminology and legal aspects of court procedures affecting legal liability

• Ability to audit claim files for consistency

• Strong ability to gather facts, analyze alternatives and recommend solutions

• Excellent organizational and analytical skills

• Excellent customer service and communication skills

• Strong computer skills, including Microsoft Office Suite

• Ability to manage multiple tasks and meet deadlines

The hiring salary range for this position will vary based on geographic location, falling within either of the following:

A hiring range represents a subset of the full salary range. The actual salary will depend on several factors, including relevant education, skills, and experience of an applicant, geographic location, and business needs.

For information relating to the benefits EMC Team Members receive as part of a comprehensive rewards package, please visit www.emcins.com/careers.

Our employment practices are in accordance with the laws that prohibit discrimination due to race, color, creed, sex, sexual orientation, gender identity, genetic information, religion, age, national origin or ancestry, physical or mental disability, medical condition, veteran status, active military status, citizenship status, marital status or any other consideration made unlawful by federal, state, or local laws.

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Originally posted on Himalayas